Outcome and cost analysis of primary total knee arthroplasty in end-stage renal disease patients: A nationwide population-based study

Renal Transplant Patients Have a Lower Risk of Complications and Mortalities After Total Knee Arthroplasty Compared to Those on Hemodialysis: A Large National Database Study

BACKGROUND

Total knee arthroplasty (TKA) in end-stage renal disease is associated with complications. Controversy exists whether elective TKA should be performed while patients are on hemodialysis (HD) or following renal transplant (RT). This study compares TKA outcomes in HD versus RT patients.

METHODS

A national database was retrospectively reviewed using International Classification of Diseases codes to identify HD and RT patients who underwent primary TKA from 2010 to 2018. Demographics, comorbidities, and hospital factors were compared using Wald and Chi-squared tests. The primary outcome was in-hospital mortalities while secondary outcomes included quality outcomes and medical/surgical complications. Multivariate regressions were used to determine independent associations. Significance was determined with a 2-tailed P value of .05. There were 13,611 patients who underwent TKA (61.1 HD and 38.9% RT). Patients who had RT were younger, had fewer comorbidities, and more likely to have private insurance.

RESULTS

The RT patients had a lower rate of mortality (odds ratio (OR) 0.23, P < .01)), complications (OR 0.63, P < .01), cardiopulmonary complications (OR 0.44, P = .02), sepsis (OR 0.22, P < .001), and blood transfusion (OR 0.35, P < .001) during the index hospitalization. This cohort was also found to have decreased length of stay (-2.0 days, P < .001), non-home discharge (OR 0.57, P < .001), and hospital cost (-$5,300, P < .001). Patients who had RT had a lower rate of readmission (OR 0.54, P < .001), periprosthetic joint infection (OR 0.50, P < .01), and surgical site infection (OR 0.37, P < .001) within 90 days.

CONCLUSION

These findings suggest that HD patients are a high-risk population in TKA compared to RT patients and warrant stringent perioperative monitoring.

Total knee arthroplasty in dialysis patients: a national in-patient sample-based study of perioperative complications

BACKGROUND

Chronic kidney disease (CKD) is a growing disease that affects millions of people in the USA every year. Many CKD patients progress to end-stage renal disease (ESRD), necessitating the use of hemodialysis to alleviate symptoms and manage kidney function. Furthermore, many of these patients have lower bone quality and experience more postoperative complications. However, there is currently limited information on hospitalization information and perioperative complications in this population following procedures such as total knee arthroplasty (TKA). The purpose of this study was to assess the patient characteristics, demographics, and prevalence of postoperative problems among dialysis patients who received TKA.

METHODS

In this retrospective study, we used the Nationwide Inpatient Sample (NIS) data from 2016 to 2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing TKA who were categorized as dialysis patients, compared with those who were not. Propensity matching was conducted to consider associated factors that may influence perioperative complications.

RESULTS

From 2016 to 2019, 558,371 patients underwent TKAs, according to the National In-Sample (NIS) database. Of those, 418 patients (0.1%) were in the dialysis group, while the remaining 557,953 patients were included in the control group. The mean age of the dialysis group was 65.4 ± 9.8 years, and the mean age in the control group was 66.7 ± 9.5 years (p = 0.006). After propensity matching, dialysis group patients had a higher risk of receiving blood transfusions [odds ratio (OR): 2; 95% confidence interval (CI): 1.2, 3.4] and a significantly larger COC in comparison to those in the control group (91,434.3 USD versus 71,943.6 USD, p < 0.001). In addition, dialysis patients had significantly higher discharges to another facility, as compared with the control group patients.

CONCLUSIONS

The dialysis group had a significantly higher cost of care, higher rates of requiring blood transfusion, and more cases of being discharged to another facility than non-dialysis patients. This data will help providers make informed decisions about patient care and resource allocation for dialysis patients undergoing TKA.

Outcome and Predictors of Septic Failure Following Total Joint Arthroplasty for Prior Septic Arthritis of Hip and Knee Joint

BACKGROUND

Arthroplasty patients with prior septic arthritis are at a high risk of developing periprosthetic joint infection (PJI). The aims of this study are to investigate the outcome and predictors of septic failure following total joint arthroplasty (TJA) for prior septic arthritis. In addition, the optimal timing of TJA is also discussed.

METHODS

A retrospective review of 105 TJA patients with prior septic arthritis between January 2000 and December 2019 was performed. Patient-specific and surgery-related factors, organism profiles, and other relevant variables were recorded.

RESULTS

At a mean follow-up of 10.3 years, the PJI rate was 16.2%. The adjusted Cox proportional hazards model showed that male gender (HR, 9.95; P < .01), end-stage renal disease (HR, 37.34; P < .01), debridement surgery ≥3 times (HR,4.75; P = .04) and polymicrobial infection in primary septic arthritis (HR, 10.02; P = .02) were independent risk factors for PJI. Neither the types of initial debridement, nor one-stage vs two-stage arthroplasty was related to the risk of PJI. While delaying the timing of TJA did not correlate with a reduction of PJI rate, there was a higher risk of PJI re-infection by the same microorganisms isolated in prior septic arthritis if TJA was performed within 6 months after septic arthritis.

CONCLUSIONS

Our study demonstrated that male gender, end-stage renal disease (ESRD), multiple debridement surgeries and polymicrobial septic arthritis predisposed septic failure of TJA following prior septic arthritis. Surgeons should counsel patients with the potential complications, and be cognizant about the risk factors pertaining to septic failure when considering TJA.

Incidence and Cost of Surgical Site Infections After Osteochondral Allograft Transplantation and Meniscal Allograft Transplantation in the Knee

Background:

Surgical site infections (SSIs) significantly influence outcomes and health care costs after orthopaedic surgery, but they have not been well characterized for osteochondral allograft (OCA) transplantation with or without meniscal allograft transplantation (MAT).

Purpose:

To characterize the incidence, cost, and risk factors associated with potential or confirmed SSIs after large single-surface, multisurface, or bipolar allograft transplantation in the knee.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Prospectively collected registry data were analyzed for patients who underwent primary or revision OCA transplantation with or without MAT in the knee. The Centers for Disease Control and Prevention (CDC) guidelines were used to define SSIs and calculate the SSI incidence. Both potential and confirmed SSIs were analyzed to determine related treatment methods, calculate associated health care costs, and characterize risk factors based on the OCA surgery type (single-surface, multisurface, bipolar, ±MAT), American Society of Anesthesiologists physical status classification system, surgery duration, length of stay, age, sex, body mass index (BMI), and current tobacco use.

Results:

A total of 224 patients were included in the analysis. There were 2 SSIs in 1 patient that met CDC criteria, such that the incidence for this patient population was 0.9%. An additional 7 patients (3.1%) were examined for potential infections not classified as SSIs. Patients with potential or confirmed SSIs had a significantly higher mean BMI compared to patients with no evidence of an SSI ( P <.001). BMI >35 (odds ratio, 9.1) and tobacco use (odds ratio, 6.6) were associated with greater odds for a potential or confirmed SSI. The mean health care costs were $6101 for patients who required additional emergency room visits and/or irrigation and debridement within 90 days postoperatively for potential or confirmed SSIs, $19 for patients with potential superficial incisional SSIs, and $12,100 for patients who experienced a potential or confirmed deep incisional or organ/space SSI >90 days from surgery.

Conclusion:

Large OCA transplantation with and without MAT were associated with a low incidence of confirmed SSIs (0.9%), and patients with BMI >35 and current tobacco use had greater odds of an SSI. Potential and confirmed SSIs were associated with unscheduled appointments, additional surgical procedures, and higher costs.

High-throughput hemodialysis on the clinical efficacy and micro-inflammatory state, calcium and phosphorus metabolism, heart and kidney function in patients with end-stage renal disease

To compare the clinical efficacy, heart and kidney function, calcium and phosphorus metabolism, serological indicators, and the effects of micro-inflammatory status after two hemodialysis treatments to evaluate the best treatment for patients with end-stage renal disease. According to the criteria for inclusion and exclusion, collected in the Department of Nephrology, third People's Hospital of Gansu Province, patients were selected and received treatment between July 2019 and July 2021. A total of 60 cases were randomized. The urea nitrogen (BUN), blood creatinine (Scr), calcium and phosphorus metabolism levels, inflammation-related factors, and serum-related indicators of the two groups of patients before and after the treatment were detected for half a year. The effective rate (83.33%) of the observation group was higher than that of the control group (66.67%). After treatment, the iPTH, β2-MG, Hcy of the observation group were lower than those of the control group, and ALB was higher than that of the control group. The inflammation-related index observation group was significantly lower than the control However, the difference in Scr and BNU index levels between the two groups of patients after treatment was not so obvious that they could not be evaluated. In terms of all indicators and parameters, high-flux hemodialysis can better treat ESRD and improve the heart and kidney function of patients.

Mid-term clinical outcomes and complications of primary total knee arthroplasty in hemodialysis patients: a retrospective comparative cohort study

Background

Numerous patients who receive hemodialysis (HD) undergo total knee arthroplasty (TKA) due to advanced knee joint arthritis. However, there are few studies that describe the clinical outcomes and complications of TKA in HD patients. This study investigated the mid-term results of TKA in patients undergoing HD.

Methods

This single-center retrospective study compared clinical and surgical outcomes following TKA in patients who were receiving HD with those who were not. We used propensity scores to match 21 knees of 18 patients who received HD to 706 knees of 569 patients who had not received HD, from a total of 727 knees (587 patients) that underwent primary unilateral TKA. The clinical outcomes were evaluated using the American Knee Society Score-knee (AKSS-knee) and AKSS-function scores. The primary surgical outcome measure was the number of knees with postoperative complications.

Results

In both the HD and non-HD groups, postoperative AKSS-knee and function scores significantly improved when compared to preoperative values. Postoperative AKSS-knee and function scores were not significantly different between the groups. The number of knees with postoperative complications was larger in the HD group than the non-HD group within the first postoperative month, 0–12 months, 12–24 months, 0–24 months, and two years after surgery. Additionally, in the HD group, more complications occurred in the first month than any subsequent month in the two years after surgery.

Conclusions

TKA improves AKSS-knee and function scores equivalently for HD patients and non-HD patients. However, HD patients develop more complications after TKA, especially within the first month. Therefore, surgeons who perform TKA for HD patients should obtain informed consent after explaining the possible complications, and HD patients should be carefully observed following TKA.

Greek gods and the double-edged sword of liver regeneration

In the current issue of the Biomedical Journal we gain an insight into the regeneration of liver tissue and how an over-the-counter supplement, stem cells and two plant extracts counteract liver damage. Furthermore the advances against hepatitis C virus are presented, the role of long non-coding RNA elucidated as well as the potential of an adhesion G protein-coupled receptor. In another contribution, the definition and evolutionary impact of copy number variants is clarified. Also, the polymorphism of a scaffolding caspase is investigated. We furthermore learn about the relation between SARS-CoV2 mutants in dependence of geography and explore the challenges of telemedicine in a complex healthcare field. A novel approach to engineering artificial grafts is presented, the challenges of total knee arthroplasty discussed as well as a possible mean of sinus floor elevation for dental implants. At last the concept of flipped classroom is scrutinized in terms of usefulness for a hospital in Taiwan.